To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .

To send content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services
Please confirm that you accept the terms of use.

Three epidemic waves of human influenza A(H7N9) were documented in several different provinces in China between 2013 and 2015. With limited understanding of the potential for human-to-human transmission, it was difficult to implement control measures efficiently or to inform the public adequately about the application of interventions. In this study, the human-to-human transmission rate for the epidemics that occurred between 2013 and 2015 in Zhejiang Province, China, was analysed. The reproduction number (R), a key indicator of transmission intensity, was estimated by fitting the number of infections from poultry to humans and from humans to humans into a mathematical model. The posterior mean R for human-to-human transmission was estimated to be 0·27, with a 95% credible interval of 0·14–0·44 for the first wave, whereas the posterior mean Rs decreased to 0·15 in the second and third waves. Overall, these estimates indicate that a human H7N9 pandemic is unlikely to occur in Zhejiang. The reductions in the viral transmissibility and the number of poultry-transmitted infections after the first epidemic may be attributable to the various intervention measures taken, including changes in the extent of closures of live poultry markets.

A total of 121 patients were included. At study end, 45% of participants in the sertraline group, 73% of those in the S+NPE group and 81% of those in the S+PAE group achieved remission (P = 0.001). A shorter time to remission was observed in the S+PAE group than in the sertraline-only group.

Conclusions

Physical exercise may be a safe and effective augmentation to antidepressant therapy in late-life major depression.

After 12 weeks, there were no significant between-group differences in change in MADRS score or in response/remission rates. However, participants in the telephone-CBT group had significantly greater improvement on some measures of work functioning than the escitalopram-alone group.

Conclusions

Combined treatment with escitalopram and telephone- administered CBT significantly improved some self-reported work functioning outcomes, but not symptom-based outcomes, compared with escitalopram alone.

The assessment of limitations in social capacities can be done with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). The aim of this study was to assess the reliability and the convergent validity of the Italian version of this scale.

Methods.

We recruited 120 consecutive patients diagnosed with schizophrenia, major depression, bipolar I disorder and anxiety disorders. Included measures were the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression Scale (CGI-S), the Personal and Social Performance Scale (PSP) and the Social and Occupational Functioning Assessment Scale (SOFAS).

Results.

The median CGI-S and BPRS scores were 5 and 16.5. Mean Mini-ICF-APP total score was 18.1. Schizophrenics' Mini-ICF-APP score was higher, while that of anxious patients was lower than in the other diagnoses. Intra-class correlations (ICC) revealed a significant inter-rater agreement for total score (ICC 0.987) and for each item of the Mini-ICF-APP. The test–retest agreement was also highly significant (ICC 0.993). The total score of the Mini-ICF-APP obtained good negative correlations with PSP (rs = −0.767) and with SOFAS scores (rs = −0.790). The distribution items of the Mini-ICF-APP showed some skewness, indicating that self-care (item 12) and mobility (item 13) were amply preserved in most patients. The Mini-ICF-APP total score was significantly correlated with both CGI-S (rs = 0.777) and BPRS (rs = 0.729).

Conclusions.

As a short instrument, the Mini-ICF-APP scale seems to be well suited to everyday psychiatric practice as a means of monitoring changes in psychosocial functioning, in particular in schizophrenic patients.

Anomalous X-ray pulsars (AXPs) are thought to be magnetars which are young isolated neutron stars with extremely strong magnetic fields of >1014 Gauss. Their tremendous magnetic fields inferred from the spin parameters provide a huge energy reservoir to power the observed X-ray emission. High-energy emission above 0.3 MeV has never been detected despite intensive search. Here, we present the possible Fermi Large Area Telescope (LAT) detection of γ-ray pulsations above 200 MeV from the AXP, 1E 2259+586, which puts the current theoretical models of γ-ray emission mechanisms of magnetars into challenge. We speculate that the high-energy γ-rays originate from the outer magnetosphere of the magnetar.

A model is developed to predict the magnitude and pattern of stress due to drying of polymer films. This model combines diffusion-and-convection equation with large deformation elasto-viscoplasticity, utilizing concentration dependent elastic and viscoplastic material properties to better represent the behavior of drying thin films.

The results show that the highest stress occurs at film surface where the concentration depletion is the highest. The magnitude of this stress is induced by increasing mass transfer across the film surface but reduced by increasing diffusion coefficient. The edge effect is significant but local, limited to about four film thicknesses. Similarly, change in substrate induces extra stress.

The UK was one of few European countries to document a substantial wave of pandemic (H1N1) 2009 influenza in summer 2009. The First Few Hundred (FF100) project ran from April–June 2009 gathering information on early laboratory-confirmed cases across the UK. In total, 392 confirmed cases were followed up. Children were predominantly affected (median age 15 years, IQR 10–27). Symptoms were mild and similar to seasonal influenza, with the exception of diarrhoea, which was reported by 27%. Eleven per cent of all cases had an underlying medical condition, similar to the general population. The majority (92%) were treated with antiviral drugs with 12% reporting adverse effects, mainly nausea and other gastrointestinal complaints. Duration of illness was significantly shorter when antivirals were given within 48 h of onset (median 5 vs. 9 days, P=0·01). No patients died, although 14 were hospitalized, of whom three required mechanical ventilation. The FF100 identified key clinical and epidemiological characteristics of infection with this novel virus in near real-time.

We consider a small droplet of water sitting on top of a heated superhydrophobic surface. A toroidal convection pattern develops in which fluid is observed to rise along the surface of the spherical droplet and to accelerate downwards in the interior towards the liquid/solid contact point. The internal dynamics arise due to the presence of a vertical temperature gradient; this leads to a gradient in surface tension which in turn drives fluid away from the contact point along the interface. We develop a solution to this thermocapillary-driven Marangoni flow analytically in terms of streamfunctions. Quantitative comparisons between analytical and experimental results, as well as effective heat transfer coefficients, are presented.

Over 50% of the global burden of tuberculosis occurs in South East Asia and the Western Pacific. Since 1950, notification rates in high-income countries in these settings have declined slowly and have remained over ten-fold greater than those in Western populations. The reasons for the slow decline are poorly understood. Using an age-structured model describing the incidence of Mycobacterium tuberculosis infection and disease applied to notification data from Hong Kong, we illustrate that in Hong Kong, a high prevalence of M. tuberculosis infection among older individuals and a high risk of disease through reactivation (e.g. up to 17-fold greater than that estimated for infected males in the United Kingdom) may explain this slow decline. If this feature of the epidemiology of tuberculosis is widespread, the WHO directly observed treatment short-course (DOTS) strategy may have a smaller impact in Asia in the short term than has been implied by recent predictions, all of which have been based on disease risk estimates derived from Western Europe. As a result, it may be difficult to meet the targets for tuberculosis control, which have been prescribed by the UN Millennium Development Goals.

Background. Although a host of studies have now examined the relationship between quality of life (QoL) and non-seasonal depression, few have measured QoL in seasonal affective disorder (SAD). We report here on results from the Can-SAD trial, which assessed the impact of treatment with either antidepressant medication or light therapy upon QoL in patients diagnosed with SAD.

Method. This Canadian double-blind, multicentre, randomized controlled trial included 96 patients who met strict diagnostic criteria for SAD. Eligible patients were randomized to 8 weeks of treatment with either: (1) 10000 lux light treatment and a placebo capsule or (2) 100 lux light treatment (placebo light) and 20 mg fluoxetine. QoL was measured with the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Medical Outcomes Study (MOS) Short-Form General Health Survey (SF-20) at baseline and 8 weeks.

Results. Both intervention groups showed significant improvement in QoL over time with no significant differences being detected by treatment condition. Q-LES-Q scores increased significantly in seven of eight domains, with the average scores rising from 48·0 (S.D.=10·7) at baseline to 69·1 (S.D.=15·6) at week 8. Treatment-related improvement in QoL was strongly associated with improvement in depression symptoms.

Discussion. Patients with SAD report markedly impaired QoL during the winter months. Treatment with light therapy or antidepressant medication is associated with equivalent marked improvement in perceived QoL. Studies of treatment interventions for SAD should routinely include broader indices of patient outcome, such as the assessment of psychosocial functioning or life quality.

Microbial biofilm formation can be influenced by many physiological and genetic factors. The conventional microtiter plate assay provides useful but limited information about biofilm formation. With the fast expansion of the biofilm research field, there are urgent needs for more informative techniques to quantify the major parameters of a biofilm, such as adhesive strength and total biomass. It would be even more ideal if these measurements could be conducted in a real-time, non-invasive manner. In this study, we used quartz crystal microbalance (QCM) and microjet impingement (MJI) to measure total biomass and adhesive strength, respectively, of S. mutans biofilms formed under different sucrose concentrations. In conjunction with confocal laser scanning microscopy (CLSM) and the COMSTAT software, we show that sucrose concentration affects the biofilm strength, total biomass, and architecture in both qualitative and quantitative manners. Our data correlate well with previous observations about the effect of sucrose on the adherence of S. mutans to the tooth surface, and demonstrate that QCM is a useful tool for studying the kinetics of biofilm formation in real time and that MJI is a sensitive, easy-to-use device to measure the adhesive strength of a biofilm.

Discharge information for all Hong Kong government hospitals, which is routinely collected through the Clinical Management System (CMS), was used to assess the relative importance of all causes of diarrhoeal illness and to address the issue of under-diagnosis of rotavirus by linking discharge diagnostic codes with actual laboratory results for one hospital. Of all children less than 5 years of age hospitalized in Hong Kong in the 2-year period July 1997 to June 1999, 12257 (11%) were discharged with a primary diarrhoea diagnosis (74% coded as non-specified, 10·4% as rotavirus, 11% as Salmonella and 5% as other viral or bacterial). Linked laboratory and discharge data for one hospital demonstrated that 15% (n=1522) of all admissions had a primary diarrhoea diagnosis and that 40% of these had a specimen sent for rotavirus testing, of which 37% were positive. However, 46% (67/145) of children with a diagnosis of rotavirus infection had no virology result, and 69% (172/248) of positive rotavirus results were in children with no diagnosis indicating rotavirus infection. Modification of the CMS to routinely combine existing computerized laboratory data with the CMS discharge diagnoses and to develop mechanisms to enhance reliability of discharge diagnosis coding could produce a powerful resource for disease surveillance, auditing and for monitoring the impact of future vaccination and other prevention programmes.

Background. Serotonergic mechanisms have been proposed for the pathophysiology of seasonal
affective disorder (SAD) and the therapeutic effect of bright-light treatment. Previously, we showed
that SAD patients, in clinical remission with light therapy during the winter, experienced transient
depressive relapses after a rapid tryptophan depletion (RTD) technique, which results in decreased
brain serotonin levels. The objective of this study was to investigate the effect of RTD in SAD
patients who were in natural summer remission.

Results. The RTD session resulted in significant reduction in total and free plasma tryptophan
levels compared to the control session. The behavioural data were analysed using repeated measures
analysis of variance. This analysis found significant main effects of time (higher scores after AA
ingestion) and diagnosis (higher scores in SAD patients), but no main effect of session or significant
interaction effects between the three factors. Thus, there were no significant behavioural effects of
RTD compared to the sham depletion control session.

Conclusions. The summer remission experienced by SAD patients is not dependent on plasma
tryptophan levels (and presumably brain serotonin function) in the same manner as that of
remission after light therapy. These results conflict with those of other laboratories, perhaps because
of differences in study samples.

Invasive meningococcal disease (IMD) is thought to occur within a few days of pharyngeal
acquisition of Neisseria meningitidis. During a longitudinal study of carriage and acquisition
among 2453 first-year undergraduates we identified a male student from whom N. lactamica
was isolated in October 1997 followed by N. meningitidis in December 1997. In mid-January
1998 this student suffered a mild episode of IMD (meningitis) during which N. meningitidis was
isolated from his CSF. The meningococcus carried in December 1997 was phenotypically and
genotypically indistinguishable from the invading organism, suggesting the possibility that the
organism may have been carried for 7 weeks prior to the onset of invasive disease. Further
studies are needed to assess more accurately the range of asymptomatic carriage prior to
disease onset.

Concerns about life support equipment accompanying the critically ill patient have to date made magnetic resonance imaging (MRI) studies of this patient group the exception. We present here a series of tests performed on an IVAC P3000 infusion pump to investigate its suitability for the magnetic resonance imaging environment. We investigate safety, pump performance and image quality issues. The pump was housed at the end of the patient couch to prevent motion towards the scanner. Gravimetric tests found the pump to work within acceptable parameters at a static field of 10 mT. Image interference issues were addressed.

Rotavirus gastroenteritis should soon be a vaccine-preventable
disease.
In a 10-year survey of
rotavirus gastroenteritis conducted at the Prince of Wales Hospital (PWH),
2281 cases were
detected of which 2213 (97%) occurred in children <5 years old. A consistent
epidemic
occurred each winter during the months of December and January. Of all
laboratory-confirmed
cases, 78% were community-acquired with a mean hospital stay of 4·7
days. The estimated
incidence of rotavirus-attributed hospitalization was 2/1000 children
<5 years old. Over the 10
years, rotavirus was responsible for one death, and contributory to three
other deaths. On
average each year, 195 children <5 years old were hospitalized for a
total of 917 days in
PWH, accounting for an estimated expenditure of HK$2·8 (∼US$0·4)
million on
hospitalization costs. The annual financial burden for rotavirus
gastroenteritis for the whole of
Hong Kong could be in excess of HK$9·6 (∼US$1·2) million.

Hypothermic circulatory arrest has been an important adjunct in pediatric cardiovascular surgery. Historically, use of hypothermia allowed the first intracardiac repair prior to the successful application of cardiopulmonary bypass and well before the advent of cardioplegic cardiac arrest. Today, the repair of many complex defectsis greatly facilitated by the use of hypothermic arrest. Despite the importance of the technique in the armamentarium of the congenital heart surgeon, the physiology of cerebral injury associated with hypothermic arrest has not been fully elucidated. To understand this physiology better, a number of investigators have focused on cerebral reperfusion after the event. In this review, we discuss findings from our own studies in the light of other available data on global and regional flow of blood to the brain following hypothermic arrest.

The risk for schizophrenia among first-degree relatives of schizophrenic probands obtained from an epidemiological sample using family history methods was examined to determine whether month of birth of the proband was associated with familial risk. The results of this study of the first-degree relatives of 106 female schizophrenics and 275 male schizophrenics suggested that the relatives of probands born in the months February to May had the highest risk, although the association between month of birth and familial risk among the male probands was present only for those relatives who had onset of schizophrenia before the age of 30.